A seven-month-old infant who was feverish, not sleeping well,
not hungry, and was fatigued, was taken by his parents to an
after-hours accident and medical centre. The doctor diagnosed a
probable viral illness and recommended that they take the boy to
his general practitioner (GP) for review and a urine test in eight
hours' time.

The GP confirmed the earlier diagnosis of probable viral illness
but wished to exclude a urinary tract infection (UTI). He ordered a
urine test, and a sample was taken via a urinary bag. A dipstick
test revealed a high protein count with no other abnormal findings.
However, as the findings were inconclusive, the doctor sent the
sample for laboratory testing, including a full culture and urine
analysis. He told the parents that there was an abnormality and
that he would contact them if results from the further testing
indicated a urinary infection. He told them to bring the boy back
if the fever did not settle or if they had further concerns.

The laboratory results, received the following day, showed large
amounts of protein and blood pigment, but no significant bacteria.
As this effectively excluded a UTI and confirmed the working
diagnosis of viral illness, the GP filed the results and took no
further action.

Three weeks later, another GP at the clinic saw the infant when
he presented with a two-day history of diarrhoea, and diagnosed
viral gastroenteritis. Five weeks later, the parents returned as
the boy appeared generally unwell. The second GP diagnosed an
allergic reaction, but ordered urine tests, which again reported a
large protein and blood pigment count, as well as the presence of
casts (an indication of renal disease). The GP was concerned about
the boy's condition and had him admitted to hospital, where he was
diagnosed with atypical haemolytic uraemic syndrome (HUS) with
accompanying hypertension and anaemia.

It was held that although the first GP was not expected to be
able to diagnose a condition that was extremely rare and was
presenting atypically, he was expected to recognise any variation
from normal and follow it up appropriately. High protein and
haematuria in a seven-month-old infant should be considered
significant until follow-up test results show otherwise. By not
following up the abnormal urine test results, the GP did not
provide services that minimised the potential harm to the infant,
and so breached Right 4(4). By not informing the parents about the
abnormal test results, he was also found to have breached Right
6(1)(f).

The clinic was found to have good systems in place for the
receipt of test results and was not found responsible for the GP's
error in judgement.